Saving the Heart of Breast Cancer Patients

ST. LOUIS – When patients are diagnosed with breast cancer they are focused on treating the disease at hand. However, according to recent studies radiation therapy could pose a danger to heart tissue leading to increased risk of ischemic heart disease for those with a left-side breast cancer.

Doctors with Mercy Cancer Services are leading the way in the St. Louis area with heart-sparing left breast radiotherapy using specialized techniques such as deep-inspiration breath holds and prone patient positioning to move the heart out of the radiation fields.

Standard 3D-conformal radiation for left-sided breast cancer often includes a portion of the heart and coronary arteries in the fields, which may lead to an increased risk for cardiac disease in long-term survivors.

For the deep-inspiration breath hold technique, patients breathe through a mouthpiece connected to an Active Breathing Coordinator (ABC) unit, which continuously monitors lung volume. The operator closes a valve at a specified lung volume to produce a breath hold. A deep breath creates increased separation between the chest wall and heart by moving the breast outward and the heart and diaphragm downward. Radiation is delivered during these repeated short breath holds. While a standard breast radiation treatment may take 10-15 minutes to deliver, radiation using deep breath holds can take 15-30 minutes depending on the duration of each breath hold.

“We want patients to feel comfortable knowing that they are not treating one disease only to have the treatment cause another serious medical condition later on,” said Dr Kathy Baglan, radiation oncologist with Mercy Cancer Services. “While many radiation centers in the St. Louis area use techniques such as 3D-planning and IMRT to reduce cardiac radiation dose, Mercy is the only center currently using techniques that can eliminate direct cardiac exposure.”

In addition to the ABC deep-inspiration breath hold technique, Mercy offers treatment in a prone – or face down – position on a special treatment table for some patients. The breast hangs down away from the chest wall, while the opposite breast remains on top of the board.

“It takes a little more time to individualize patient care with these techniques, but we believe our patients and their hearts are worth the extra effort,” Dr. Baglan said.

Mercy Hospital St. Louis, part of Mercy’s east Missouri region, is a 979-bed comprehensive teaching hospital. The 80-acre site houses a nine-level heart and vascular hospital, a cancer center; a comprehensive children's hospital; a surgery center; and a 120-bed skilled nursing center.

Mercy is the sixth largest Catholic health care system in the U.S. and serves more than 3 million people annually. Mercy includes 32 hospitals, 300 outpatient facilities, 38,000 co-workers and 1,900 integrated physicians in Arkansas, Kansas, Missouri and Oklahoma. Mercy also has outreach ministries in Louisiana, Mississippi and Texas. In Mercy’s east Missouri region, Mercy’s services include a 979-bed hospital in St. Louis, 187-bed hospital in Washington, 251-bed hospital in Crystal City and Mercy Clinic, a 570-member multispecialty physician organization.